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weekday evening one's first impression is noise. Hard rock competes with conversation punctuated by occasional shouts and gusts of laughter. After one's eyes adapt to the smoky air comes the second impression-color. The exposed overhead pipes are bright red, the walls yellow, the support beams green. There are splashes of purple, electric blue, shocking pink in the psychedelic murals and posters. As individual people come into focus, they all appear young, their dress casual in the extreme. It looks like a casting call for an amateur production of Hair. This is the waiting room of the Pittsburgh Free Clinic. Furnishings are cracked leather couches supported by stacks of bricks instead of legs, thrift shop rejects, with a church pew here and there. On one side of the room there are a record player, a magazine box, a brick-and-raw-lumber bookcase with used volumes, a Coke machine, and a table with the makings of instant coffee, tea, cocoa, and soup. Other bookcases hold the minutes of previous board meetings, health-related pamphlets, and news of the clinic in mimeographed form. There is also literature about venereal disease, family planning, abortion, and drug abuse, published by Blue Cross, health departments, and drug companies. A birth control handbook gives accurate and complete information about anatomy, physiology, and family planning methods. It contains, as well, sections on the political issues surrounding such topics-all in the style of the underground press. The two desks are manned by people who look and dress like all of the others sitting, standing, moving, and occasionally breaking into dance. Posters and signs cover the walls. Some advertise rock concerts, lectures on macrobiotics, art shows, women's liberation activities, sources of legal help. The antiwar theme is well represented and the antidrug, pro-mental-health message is carried by signs: "Still shooting dope? Stop living like a dead man" (pencilled in, "or woman"), "Call Alpha House," or "Hepatitis is a bad trip ... If you think you have it or have been exposed to it, call for free blood tests." Other posters relate directly to the clinic. Two list the standard local prices for routine tests, medications, and services, and the cost of same services at the clinic. Another, by the door, reads "All donations appreciated; we need the bread." One, obviously handmade ith a Magic Marker, lists the services offered. They include medical, gynecological, and dermatology care; nutrition; legal, personal, birth control, pregnancy, and venereal disease counseling. A cafeteria foodlist board announces the date of the next board meeting and urges everyone interested to attend. Give or take a few details, this is a typical scene in any free clinic in the United States. There are now about 200 of them treating over 2,000,000 people a year in storefronts, walk-ups, fire-gutted taverns, church basements, or wherever the space is cheap or free and convenient(l). This ease of access is crucial, because those who have adopted the hip life style can be as physically, economically, and psychologically barred from conventional sources of health care as members of any other minority or subculture in the country. Emergency rooms and outpatient clinics of large public hospitals and health departments are frequently far from the hip or student neighborhoods. Transportation is likely to be unavailable or prohibitively timeconsuming, hours of operation to be inconvenient. The wait can be long, the red tape longer, and secrecy, anonymity, or human dignity not considered. And the attitudes of clinic personnel can constitute a formidable barrier. We hear many accounts of humiliation and cruelty. To a runaway teenager with a venereal disease and a drug problem, an agency that aggressively pushes a thorough investigation of his sexual contacts can be threatening enough to make him put off treatment dangerously long. People who have venereal disease are asked to bring in their contacts for treatment or to refer them to the health department. If they do not bring their contacts in within two weeks, contacts' names are given to the health department and a social worker is assigned to locate them. Even young people who still live at home, though more or less alienated from their families and straight society, cannot use conventional me ical care for certain of their needs. Can you imagine the average middle-class, fourteen-year-old girl going to her pediatrician or her mother's gynecologist for an intrauterine device or a pregnancy test? MADALON M. AMENTA (B.A. Tufts University, Boston, Mass.; M.N., Yale University, New Haven, Conn.; M.P.H., University of Pittsburgh, Pa.), a doctoral student at the University of Pittsburgh, was formerly an instructor at that university. She acknowledges the special help of Kathy Chajkowski, Mary Curtiss, and Miriam Winikoff in sharing their thoughts and feelings about their experience in the Pittsburgh Free Clinic.

Discriminant functions maximize the discriminating power of a group of laboratory tests and, in addition, offer a powerful method for evaluating the contribution of a new test to our diagnostic capabilities. In this study discriminant functions were used to evaluate the contributions of the various phosphate clearance tests in distinguishing between patients with hyperparathyroidism and control patients. The routine phosphate clearance and the phosphate-creatinine clearance ratio did not add significant information to the discriminant. A small but significant amount of discriminant power was added by either the phosphate-creatinine clearance ratio or the change in phosphate-creatinine ratios after calcium infusion. This analysis demonstrates that in difficult cases the addition of one of these two clearance tests to the usual analyses of serum calcium and phosphorus increases our diagnostic capability and provides more accurate diagnoses. For the data in this study the proposed discriminant function positively distinguishes patients with hyperparathyroidism from patients without this disease. These results demonstrate that discriminant functions can optimize diagnostic classification and, equally important to the clinical laboratory scientist, provide a formal mechanism by which to evaluate the effectiveness of any laboratory procedure.

When portions of the cytoplasm of fibroblasts cultured from mouse embryo tissues are irradiated with heterochromatic microbeams of ultraviolet light, lymphocytes are attracted (Lymphotaxis) to the injured areas. The lymphocytes approach in the “hand mirror” shape characteristic of tissue cultures. On reaching the fibroblast, pseudopodia shoot out to “lick” the wound and then the lymphocyte “worms” its way across the cell. Only one lymphocyte contacts a fibroblast but the same one may make several passes. It is postulated that lymphocytes are cleaning the wounded area of undesirable irradiation products and/or applying healing substances to the wounded fibroblast. Irradiation of lymphocytes in portions of the cytoplasm fails to evoke responses from nearlby lymphocytes. Instead, the cytoplasm whirls around the nucleus as if the irradiation products can not leave the cell, resulting in convulsions and death. A technique is described by which relatively pure cultures of lymphocytes may be obtained from leukocyte cultures by selectively killing all granular leukocytes with excessive exposure to microbeams of ultraviolet light. Lymphocytes are harvested and introduced into fibroblast cultures to study experimental lymphotaxis.

In flattened cells cultured from the heart of Triturus viridescens, cytoplasmic vesicles possessing a decreased refractive index were observed in the vicinity of the nucleus. The vesicles displayed a bubbling phenomenon when viewed by dark medium phase contrast microscopy and recorded by time lapse photography. Usual fat stains failed to reveal the vesicles in fixed preparations. DaFano's and Aoyama's methods employing silver imparted a brown-yellow color to the vesicles, but because the cell nucleus also stained the same color, no identification could be advanced. Heterochromatic microbeams of ultraviolet light focused into the vesicular complex caused swelling and fusion of the vesicles, followed by regression in size until they could no longer be seen. Cytoplasmic irradiation adjacent to and at relatively great distances from the vesicles failed to evoke this reaction from the vesicles. An interesting side effect was recorded in the nucleus: a diminished granularity of the chromatin. This effect was likened to previously recorded cytoplasmic irradiation effects; that of nuclear pyknosis in eosinophils, and spindle destruction in early mitotic cells. Irradiation of fat droplets caused none of these effects. Further studies are aimed at defining the nature of these vesicles, with emphasis on the vesicles being pinocytotic vesicles, endoplasmic reticulum or Golgi vesicles.

Hydrazine and derivations affecting carbon dioxide respiratory pattern of various metabolic substrates in rats

An operational computer-assisted laboratory information system is presented. This system simplifies the clerical operations at the nursing station, in the accounting office, and in the laboratory. It permits utilization of shared computer facilities on an economic basis for the preparation of improved clinical reports and for more effective laboratory control, teaching, consultation, and administration. Computer transfer of the data to tape and a tape drive accessory will provide data retrieval.

The Lipiodol absorption test, quantifying urinary iodide concentration 8-12 hr. after ingestion of Lipiodol, is proposed as an effective screening technic for lipid malabsorption. Urinary iodide is converted to free iodine with nitrous acid; the free iodine is extracted into chloroform, producing a characteristic pink color which is quantified photometrically. Under the dosage conditions used, a urinary iodide concentration of less than 0.4 mM/L strongly suggests abnormal absorption of fat. The results of this test have been correlated with fat balance studies in 12 patients with symptoms of intestinal disease and 12 patients asymptomatic for intestinal disease. The screening test was abnormal in all 7 patients with abnormal fat balance studies and in 2 patients with normal fat balance studies. The remaining 15 patients had a normal screening test and normal fat balance studies. No false negatives were found. The simplicity of the test, coupled with its high correlation with the fat balance studies, recommend its use in the clinical laboratory as a valid screening procedure in all patients with suspected steatorrhea.

Mucin-producing carcinoma of the female breast was studied by histochemistry, electron microscopy and tissue culture. The tumor cells and lakes of secretion contained strong and weak acidic mucins. Weakly acidic mucins were abundant in areas of adjacent atypical intraductal hyperplasia. Mucin production in the benign atrophic areas was scanty and mainly of the neutral variety. Electron microscopy revealed elaborate organelle morphology as compared to the simple structure of the more common infiltrating duct carcinoma. In cell culture the tumor cells proliferated and produced mucin for 6 weeks through 2 subcultures.

When a chromosome segment is selectively irradiated with an ultraviolet micro-beam, the chromosome(s), which normally appear black by medium-dark phase-contrast microscopy, become “pale” in the irradiated region (decrease in refractive index). Previous ultraviolet absorption and Feulgen staining studies indicated that all or most of the deoxyribonucleic acid is lost in this region. After fixation, the irradiated area appears pale with most of the usual staining methods. The residual material in the paled spot, however, can be stained with the Comori alkaline phosphatase technique and is seen to be directly continuous with the nonirradiated segments. With the bright field microscope, there appears to be no decrease or increase in chromosome width. It is concluded that staining by the Gomori technique is independent of the presence or absence of deoxyribonucleic acid. Positive staining of chromosomes by the nonenzymatic peroxide method of Danielli indicated that staining was due to nonspecific precipitation...

Acid mucopolysaccharide (AMP) content in pleural and peritoneal fluid is quantified by precipitating the AMP with acid ethanol, solubilized in a dilute NaOH solution, and reacting the hexuronic acid with the carbazole reagent. An Allen correction in the final reading step eliminates the effects of interfering substances. This simplified analysis for AMP, by only partially purifying the AMP prior to color development, has been found suitable for use in the clinical laboratory. Studies on effusions from 11 patients have shown no detectable AMP by this method in seven patients without mesotheliomas and significant elevations of AMP in all three patients with untreated mesotheliomas. One patient with mesothelioma, previously treated with chemotherapy, had no detectable levels on two separate occasions. The determination of AMP in pleural and peritonea] fluid is a useful and practical adjunct to the clinical diagnosis of mesothelioma.